It's fair to say that a higher salary usually isn't the first thing most people think of when they hear the term “government job.” But in the past year or so, better-paying positions and attractive multiyear signing bonuses have helped the U.S. Veterans Affairs Department lure away behavioral healthcare workers from local community providers.
In an ongoing effort to boost its mental-health services program for veterans, the VA has hired nearly 3,800 mental-health workers—including physicians, nurses, pharmacists, social workers and clinical psychologists—since 2005, most of whom were hired in the past 18 months, says Antonette Zeiss, a clinical psychologist and deputy chief of mental health services at the VA. And according to Brad Karlin, director of psychotherapy programs at the VA, the VA has funded 4,300 positions, which means it will look to hire at least another 500 mental healthcare professionals in the near future.
The department, with a total mental-health workforce of almost 17,000 employees, expects total mental-health spending for fiscal 2008 to be roughly $3.6 billion. This compares with $3.2 billion in 2007 and an expected budget of almost $3.9 billion in 2009.
To be sure, there's a strong need for the VA to bolster its mental-health staff. According to the VA, since the start of combat in Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom, nearly 800,000 service members have been discharged and are eligible for VA care. Of those, more than one-third sought medical care within the VA. In a Senate Veterans Affairs Committee meeting last August, Zeiss testified that mental disorders were the second most commonly reported health concern, second only to musculoskeletal ailments (primarily joint and back disorders).
In addition, an internal report from the Army in late January showed the number of active-duty suicides was 89 with 32 deaths pending investigation, which would make for a nearly 20% increase from the 102 confirmed active-duty suicides in 2006. And the rate of suicides for the Army in 2006 was 17.5 per 100,000 soldiers, much higher than the 12.7 during the Lebanon and Grenada crises that started in 1983, and 15.7 in 1993-94 after Somalia operations, which began in 1992, according to the Army's report. Beginning in 2007, the VA has added a suicide prevention coordinator at each VA medical facility, Karlin says. The person in that role not only trains VA staff, but also connects with the local community on suicide prevention.
But while the VA's recruitment effort is necessary based on those statistics, it has put a strain on community-based mental-health providers working to meet the needs of patients as they struggle to retain staff.
“There's already a shortage of qualified people who want to do these jobs, so when our agencies lose them to places like the VA, it creates two problems,” says Chuck Ingoglia, vice president for public policy at the National Council for Community Behavioral Healthcare in Rockville, Md., which represents 1,400 community-based mental-health programs. As Ingoglia explains, the first problem is that the practices take staff members out of a facility's rotations, which not only affects revenue but also leads to the second problem of human resource departments having to recruit to fill those open positions.
“Obviously, we've been trying to encourage the VA to partner with existing resources,” Ingoglia says. “Consistently what we've heard back (is) local individual VA medical centers have little interest in partnering. We're not pursuing this because the VA is bad. What we're hearing from communities is that the reality is that we have people who live very far from VA facilities. If you get early treatment, you have a possibility of ameliorating consequences.”
For its part, the VA says it already engages in contracting services in some regions of the country.
“Certainly our focus on these new positions is on hiring permanent, full-time staff because we really want to promote sustainable, evidence-based programs,” Karlin says. “At the same time though, we certainly do engage in contract arrangements—more on a temporary basis to make sure that the full spectrum of services is available. Really that is a short-term measure. If there are particular difficulties to hiring a specific discipline, it would be appropriate to contract.”
In December 2007, Ingoglia sent an e-mail to the group's members—which include mostly government-based and not-for-profit community health centers, community mental-health centers and addiction-service programs in urban and rural areas—to ask if they had lost staff members to the VA.
“It lit up like a Christmas tree,” Ingoglia says of the response rate. “People from all areas of the country—losing all different levels of staff. The story consistently was that the VA was paying substantially higher salaries and signing bonuses that local providers can't compete with.” Ingoglia says he has received responses from members in 22 states.